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Notes Unit 17
Sexually-Transmitted Diseases
Structure and Function of the Reproductive System
The female reproductive system contains many kinds of normal flora in the vagina. The male reproductive
system, on the other hand, is usually sterile, except for maybe microbes at the opening of the penis (from the
skin). However, the reproductive system is subject to opportunistic infections that can be quite troublesome.
Most diseases of the reproductive system are transmitted by sexual activity.
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Urinary System Diseases
With the urinary system being so close to the genitals and anus, sometimes this normally sterile part of the body
can become infected. In females, the urethra is only 2 inches long, so they are mostly affected. Two main types
of disease can result:
1) Cystitis – inflammation of the urinary bladder in females. Symptoms include painful urination, with blood
and pus and bacteria in normally sterile urine.
2) Pyelonephritis – inflammation of kidney(s). Symptoms include fever, back pain, and if progresses without
treatment, can permanently damage the kidneys.
Important Diseases of Reproductive System
1. Gonorrhea
What Is Gonorrhea?
Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a
bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the
cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra
(urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.
How Common Is Gonorrhea?
Gonorrhea is a very common infectious disease. CDC estimates that more than 700,000 persons in the U.S. get
new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132
cases of gonorrhea were reported to CDC. In the period from 1975 to 1997, the national gonorrhea rate
declined, following the implementation of the national gonorrhea control program in the mid-1970s. After a
small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported
gonorrheal infections was 113.5 per 100,000 persons.
How Do People Get Gonorrhea?
Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur
for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery.
People who have had gonorrhea and received treatment may get infected again if they have sexual contact with
a person infected with gonorrhea.
Who Is At Risk For Gonorrhea?
Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of
infection are among sexually active teenagers, young adults, and African Americans.
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What Are The Signs And Symptoms Of Gonorrhea?
Although many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms
that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and
signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis.
Sometimes men with gonorrhea get painful or swollen testicles. In women, the symptoms of gonorrhea are
often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can
be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in
women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding
between periods. Women with gonorrhea are at risk of developing serious complications from the infection,
regardless of the presence or severity of symptoms. Symptoms of rectal infection in both men and women may
include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may
cause no symptoms. Infections in the throat may cause a sore throat but usually causes no symptoms.
What Are The Complications Of Gonorrhea?
Untreated gonorrhea can cause serious and permanent health problems in both women and men. In women,
gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million women each year in the
United States develop PID. Women with PID do not necessarily have symptoms. When symptoms are present,
they can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled
“pockets” that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes
enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening
condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube. In men, gonorrhea can
cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Gonorrhea can
spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more
easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit
HIV to someone else.
How Does Gonorrhea Affect A Pregnant Woman And Her Baby?
If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth
canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby.
Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications.
Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as
necessary.
How Is Gonorrhea Diagnosed?
Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing
from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a
laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by
testing a urine sample. A quick laboratory test for gonorrhea that can be done in some clinics or doctor's offices
is a Gram stain. A Gram stain of a sample from a urethra or a cervix allows the doctor to see the gonorrhea
bacterium under a microscope. This test works better for men than for women.
What Is The Treatment For Gonorrhea?
Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of
gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of
gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another
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sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea
should be tested for other STDs. It is important to take all of the medication prescribed to cure gonorrhea.
Although medication will stop the infection, it will not repair any permanent damage done by the disease.
People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with
persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she
should return to a doctor to be reevaluated.
How Can Gonorrhea Be Prevented?
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to
be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be
uninfected. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of
gonorrhea. Any genital symptoms such as discharge or burning during urination or unusual sore or rash should
be a signal to stop having sex and to see a doctor immediately. If a person has been diagnosed and treated for
gonorrhea, he or she should notify all recent sex partners so they can see a health care provider and be treated.
This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also
reduce the person's risk of becoming re-infected. The person and all of his or her sex partners must avoid sex
until they have completed their treatment for gonorrhea.
2. Chlamydia
What is Chlamydia?
Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis,
which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or
absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a
woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.
How Common is Chlamydia?
Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. In 2004,
929,462 chlamydial infections were reported to CDC from 50 states and the District of Columbia. Underreporting is substantial because most people with chlamydia are not aware of their infections and do not seek
testing. Also, testing is not often done if patients are treated for their symptoms. An estimated 2.8 million
Americans are infected with chlamydia each year. Women are frequently re-infected if their sex partners are not
treated.
How Do People Get Chlamydia?
Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected
mother to her baby during vaginal childbirth. Any sexually active person can be infected with chlamydia. The
greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus)
of teenage girls and young women is not fully matured, they are at particularly high risk for infection if sexually
active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for
chlamydial infection.
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What Are The Symptoms Of Chlamydia?
Chlamydia is known as a "silent" disease because about three quarters of infected women and about half of
infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms
might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads
from the cervix to the fallopian tubes (tubes that carry eggs from the ovaries to the uterus), some women still
have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during
intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating.
Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are
uncommon. Men or women who have receptive anal intercourse may acquire chlamydial infection in the
rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of
women and men having oral sex with an infected partner.
What Complications Can Result From Untreated Chlamydia?
If untreated, chlamydial infections can progress to serious reproductive and other health problems with both
short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often
"silent." In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic
inflammatory disease (PID). This happens in up to 40 percent of women with untreated chlamydia. PID can
cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic
pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Women infected
with chlamydia are up to five times more likely to become infected with HIV, if exposed. To help prevent the
serious consequences of chlamydia, screening at least annually for chlamydia is recommended for all sexually
active women age 25 years and younger. An annual screening test also is recommended for older women with
risk factors for chlamydia (a new sex partner or multiple sex partners). All pregnant women should have a
screening test for chlamydia. Complications among men are rare. Infection sometimes spreads to the
epididymis (a tube that carries sperm from the testis), causing pain, fever, and, rarely, sterility. Rarely, genital
chlamydial infection can cause arthritis that can be accompanied by skin lesions and inflammation of the eye
and urethra (Reiter's syndrome).
How Does Chlamydia Affect A Pregnant Woman And Her Baby?
In pregnant women, there is some evidence that untreated chlamydial infections can lead to premature delivery.
Babies who are born to infected mothers can get chlamydial infections in their eyes and respiratory tracts.
Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns.
How is Chlamydia Diagnosed?
There are laboratory tests to diagnose chlamydia. Some can be performed on urine, other tests require that a
specimen be collected from a site such as the penis or cervix.
What Is The Treatment For Chlamydia?
Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of
doxycycline (twice daily) are the most commonly used treatments. HIV-positive persons with chlamydia should
receive the same treatment as those who are HIV negative. All sex partners should be evaluated, tested, and
treated. Persons with chlamydia should abstain from sexual intercourse until they and their sex partners have
completed treatment, otherwise re-infection is possible. Women whose sex partners have not been
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appropriately treated are at high risk for re-infection. Having multiple infections increases a woman's risk of
serious reproductive health complications, including infertility. Retesting should be considered for women,
especially adolescents, three to four months after treatment. This is especially true if a woman does not know if
her sex partner received treatment.
How Can Chlamydia Be Prevented?
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be
in a long-term mutually monogamous relationship with a partner who has been tested and is known to be
uninfected. Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of
chlamydia. Chlamydia screening is recommended annually for all sexually active women 25 years of age and
younger. An annual screening test also is recommended for older women with risk factors for chlamydia (a new
sex partner or multiple sex partners). All pregnant women should have a screening test for chlamydia. Any
genital symptoms such as discharge or burning during urination or unusual sore or rash should be a signal to
stop having sex and to consult a health care provider immediately. If a person has been treated for chlamydia (or
any other STD), he or she should notify all recent sex partners so they can see a health care provider and be
treated. This will reduce the risk that the sex partners will develop serious complications from chlamydia and
will also reduce the person's risk of becoming re-infected. The person and all of his or her sex partners must
avoid sex until they have completed their treatment for chlamydia.
3. Syphilis
What Is Syphilis?
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often
been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of
other diseases.
How Common Is Syphilis?
In the United States, health officials reported over 32,000 cases of syphilis in 2002, including 6,862 cases of
primary and secondary (P&S) syphilis. In 2002, half of all P&S syphilis cases were reported from 16 counties
and 1 city; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of infectious
syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of
congenital syphilis in newborns decreased from 2001 to 2002, with 492 new cases reported in 2001 compared to
412 cases in 2002. Between 2001 and 2002, the number of reported P & S syphilis cases increased 12.4
percent. Rates in women continued to decrease, and overall, the rate in men was 3.5 times that in women. This,
in conjunction with reports of syphilis outbreaks in men who have sex with men (MSM), suggests that rates of
syphilis in MSM are increasing.
How Do People Get Syphilis?
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the
external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission
of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the
babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming
pools, hot tubs, bathtubs, shared clothing, or eating utensils.
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What Are The Signs And Symptoms In Adults?
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late
complications if they are not treated. Although transmission appears to occur from persons with sores who are
in the primary or secondary stage, many of these sores are unrecognized. Thus, most transmission is from
persons who are unaware of their infection.
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Primary Stage
The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but
there may be multiple sores. The time between infection with syphilis and the start of the first symptom can
range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It
appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without
treatment. However, if adequate treatment is not administered, the infection progresses to the secondary
stage.
Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with
the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes
associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre
has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots
both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance
may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes
rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes,
symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss,
headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will
resolve with or without treatment, but without treatment, the infection will progress to the latent and late
stages of disease.
Late (or Tertiary) Stage
The latent (hidden) stage of syphilis begins when secondary symptoms disappear. Without treatment, the
infected person will continue to have syphilis even though there are no signs or symptoms; infection
remains in the body. In the late stages of syphilis, it may subsequently damage the internal organs,
including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may
show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating
muscle movements, paralysis, numbness, gradual blindness, and dementia. May also have lesions called
gummas, which are rubbery masses of tissue on skin and organs. Damage may be serious enough to cause
death.
How Does Syphilis Affect A Pregnant Woman And Her Baby?
The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a
pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of
giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of
disease. However, if not treated immediately, the baby may develop serious problems within a few weeks.
Untreated babies may become developmentally delayed, have seizures, or die.
How Is Syphilis Diagnosed?
Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using
a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show
up when observed through the microscope. A blood test is another way to determine whether someone has
syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an
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accurate, safe, and inexpensive blood test. A low level of antibodies will stay in the blood for months or years
even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect
and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.
What Is The Link Between Syphilis And HIV?
Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There
is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present. Ulcerative STDs
that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that
provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they
come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to
HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker
for behaviors associated with HIV transmission.
What Is The Treatment For Syphilis?
Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure
a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had
syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat
syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the
syphilis bacterium and prevent further damage, but it will not repair damage already done. Because effective
treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual
behaviors put them at risk for STDs. Persons who receive syphilis treatment must abstain from sexual contact
with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex
partners so that they also can be tested and receive treatment if necessary.
Will Syphilis Recur?
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can
still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because
syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has
syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after
treatment has been received.
How Can Syphilis Be Prevented?
The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from
sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested
and is known to be uninfected. Avoiding alcohol and drug use may also help prevent transmission of syphilis
because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other
about their HIV status and history of other STDs so that preventive action can be taken. Genital ulcer diseases,
like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom,
as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of
syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is
protected.
Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other
lubricated condoms in protecting against the transmission of STDs. Based on findings from several research
studies, N-9 may itself cause genital lesions, providing a point of entry for HIV and other STDs. In June 2001,
the CDC recommended that N-9 not be used as a microbicide or lubricant during anal intercourse. Transmission
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of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and or douching after sex.
Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex
and to see a doctor immediately.
4. Herpes
What Is Genital Herpes?
Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1)
and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs
or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more
blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two
to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the
first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the
body indefinitely, the number of outbreaks tends to decrease over a period of years.
How Common Is Genital Herpes?
Results of a nationally representative study show that genital herpes infection is common in the United States.
Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had
genital HSV infection. Between the late 1970s and the early 1990s, the number of Americans with genital
herpes infection increased 30 percent. Genital HSV-2 infection is more common in women (approximately one
out of four women) than in men (almost one out of five). This may be due to male-to-female transmissions
being more likely than female-to-male transmission.
How Do People Get Genital Herpes?
HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released
between outbreaks from skin that does not appear to be broken or to have a sore. Generally, a person can only
get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can
occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called "fever
blisters." HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person
who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.
What Are The Signs And Symptoms Of Genital Herpes?
Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur
during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks
after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms
during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and
swollen glands. However, most individuals with HSV-2 infection may never have sores, or they may have very
mild signs that they do not even notice or that they mistake for insect bites or another skin condition. Most
people diagnosed with a first episode of genital herpes can expect to have several (typically four or five)
outbreaks (symptomatic recurrences) within a year. Over time these recurrences usually decrease in frequency.
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What Are The Complications Of Genital Herpes?
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in
people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes
psychological distress in people who know they are infected. In addition, genital HSV can cause potentially
fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a first
episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes
at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes
infection is rare. Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make
people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
How Is Genital Herpes Diagnosed?
The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital
herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a
laboratory. HSV infections can be difficult to diagnose between outbreaks. Blood tests, which detect HSV-1 or
HSV-2 infection, may be helpful, although the results are not always clear-cut.
Is There A Treatment For Herpes?
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during
the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic
herpes can reduce transmission to partners.
How Can Herpes Be Prevented?
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain
from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been
tested and is known to be uninfected. Genital ulcer diseases can occur in both male and female genital areas
that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent
use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential
exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex
condoms cannot guarantee protection from genital herpes. Persons with herpes should abstain from sexual
activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know
that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected
persons should be advised that they may become infected. Sex partners can seek testing to determine if they are
infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.
5. Genital Warts
What Is Genital HPV Infection?
Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV).
Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types.
More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women
including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or
rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection
on their own. Some of these viruses are called "high-risk" types, and may cause abnormal Pap tests. They may
also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types, and they may
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cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that
appear in the genital area, and sometimes are cauliflower shaped.
How Common Is HPV?
Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men
and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women
will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each
year.
How Do People Get Genital HPV Infections?
The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections
have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can
transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery.
A baby that is exposed to HPV very rarely develops warts in the throat or voice box.
What Are The Signs And Symptoms Of Genital HPV Infection?
Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or
mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have precancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital
cancers. Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area.
They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can
appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh.
After sexual contact with an infected person, warts may appear within weeks or months, or not at all. Genital
warts are diagnosed by visual inspection. Visible genital warts can be removed by medications the patient
applies, or by treatments performed by a health care provider. Some individuals choose to forego treatment to
see if the warts will disappear on their own. No treatment regimen for genital warts is better than another, and
no one treatment regimen is ideal for all cases.
How Is Genital HPV Infection Diagnosed?
Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancerscreening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV.
Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap
test abnormalities, or in women >30 years of age at the time of Pap testing. The results of HPV DNA testing can
help health care providers decide if further tests or treatment are necessary. No HPV tests are available for
men.
Is There A Cure For HPV?
There is no "cure" for HPV infection, although in most women the infection goes away on its own. The
treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such
as warts and pre-cancerous changes in the cervix.
What Is The Connection Between HPV And Cervical Cancer?
All types of HPV can cause mild Pap test abnormalities which do not have serious consequences.
Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical
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cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable
within two years. Although only a small proportion of women have persistent infection, persistent infection
with "high-risk" types of HPV is the main risk factor for cervical cancer. A Pap test can detect pre-cancerous
and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if
necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop
into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible
for greatly reducing deaths from cervical cancer. For 2004, the American Cancer Society estimates that about
10,520 women will develop invasive cervical cancer and about 3,900 women will die from this disease. Most
women who develop invasive cervical cancer have not had regular cervical cancer screening.
How Can People Reduce Their Risk For HPV Infection?
The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another
individual. For those who choose to be sexually active, a long-term, mutually monogamous relationship with
an uninfected partner is the strategy most likely to prevent future genital HPV infections. However, it is difficult
to determine whether a partner who has been sexually active in the past is currently infected. For those
choosing to be sexually active and who are not in long-term mutually monogamous relationships, reducing the
number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV
infection. Partners less likely to be infected include those who have had no or few prior sex partners. HPV
infection can occur in both male and female genital areas that are covered or protected by a latex condom, as
well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown,
condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.
6. Trichomoniasis
What Is Trichomoniasis?
Trichomoniasis is a common sexually transmitted disease (STD) that affects both women and men, although
symptoms are more common in women.
How Common Is Trichomoniasis?
Trichomoniasis is the most common curable STD in young, sexually active women. An estimated 7.4 million
new cases occur each year in women and men.
How Do People Get Trichomoniasis?
Trichomoniasis is caused by the single-celled protozoan parasite, Trichomonas vaginalis. The vagina is the
most common site of infection in women, and the urethra (urine canal) is the most common site of infection in
men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area
outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or
women, but men usually contract it only from infected women.
What Are The Signs And Symptoms Of Trichomoniasis?
Most men with trichomoniasis do not have signs or symptoms; however, some men may temporarily have an
irritation inside the penis, mild discharge, or slight burning after urination or ejaculation. Some women have
signs or symptoms of infection which include a frothy, yellow-green vaginal discharge with a strong odor. The
infection also may cause discomfort during intercourse and urination, as well as irritation and itching of the
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female genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within
5 to 28 days of exposure.
What Are The Complications Of Trichomoniasis?
The genital inflammation caused by trichomoniasis can increase a woman's susceptibility to HIV infection if
she is exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes
HIV to her sex partner(s).
How Does Trichomoniasis Affect A Pregnant Woman And Her Baby?
Pregnant women with trichomoniasis may have babies who are born early or with low birth weight (less than
five pounds).
How Is Trichomoniasis Diagnosed?
For both men and women, a health care provider must perform a physical examination and laboratory test to
diagnose trichomoniasis. The parasite is harder to detect in men than in women. In women, a pelvic
examination can reveal small red ulcerations (sores) on the vaginal wall or cervix.
What Is The Treatment For Trichomoniasis?
Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose.
The symptoms of trichomoniasis in infected men may disappear within a few weeks without treatment.
However, an infected man, even a man who has never had symptoms or whose symptoms have stopped, can
continue to infect or re-infect a female partner until he has been treated. Therefore, both partners should be
treated at the same time to eliminate the parasite. Persons being treated for trichomoniasis should avoid sex until
they and their sex partners complete treatment and have no symptoms. Metronidazole can be used by pregnant
women. Having trichomoniasis once does not protect a person from getting it again. Following successful
treatment, people can still be susceptible to re-infection.
How Can Trichomoniasis Be Prevented?
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be
in a long-term mutually monogamous relationship with a partner who has been tested and is known to be
uninfected. Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of
trichomoniasis. Any genital symptom such as discharge or burning during urination or an unusual sore or rash
should be a signal to stop having sex and to consult a health care provider immediately. A person diagnosed
with trichomoniasis (or any other STD) should receive treatment and should notify all recent sex partners so
that they can see a health care provider and be treated. This reduces the risk that the sex partners will develop
complications from trichomoniasis and reduces the risk that the person with trichomoniasis will become reinfected. Sex should be stopped until the person with trichomoniasis and all of his or her recent partners
complete treatment for trichomoniasis and have no symptoms.
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7. Pubic Lice (Crabs)
What are pubic lice?
Also called "crabs," pubic lice are parasitic insects found in the genital area of humans. Infection is common
and found worldwide. Caused by an organism called Phthirus pubis, an insect-like parasite.
How did I get pubic lice?
Pubic lice are usually spread through sexual contact. Rarely, infestation can be spread through contact with an
infested person's bed linens, towels, or clothes. A common misunderstanding is that infestation can be spread by
sitting on a toilet seat. This isn't likely, since lice cannot live long away from a warm human body. Also, lice do
not have feet designed to walk or hold onto smooth surfaces such as toilet seats. Infection in a young child or
teenager may indicate sexual activity or sexual abuse.
Where are pubic lice found?
Pubic lice are generally found in the genital area on pubic hair; but may occasionally be found on other coarse
body hair, such as hair on the legs, armpits, mustache, beard, eyebrows, or eyelashes. Infestations of young
children are usually on the eyebrows or eyelashes. Lice found on the head are not pubic lice; they are head lice.
Animals do not get or spread pubic lice.
What are the signs and symptoms of pubic lice?
Signs and symptoms of pubic lice include itching in the genital area and/or visible nits (lice eggs) or crawling
lice.
What do pubic lice look like?
There are three stages in the life of a pubic louse: the nit, the nymph, and the adult.
Nit: Nits are pubic lice eggs. They are hard to see and are found firmly attached to the hair shaft. They are
about the size of the mark at the end of this arrow
. They are oval and usually yellow to white. Nits take
about 1 week to hatch.
Nymph: The nit hatches into a baby louse called a nymph. It looks like an adult pubic louse, but it is smaller.
Nymphs mature into adults about 7 days after hatching. To live, the nymph must feed on blood.
Adult: The adult pubic louse is about the size of this circle
and resembles a miniature crab when viewed
through a strong magnifying glass. Pubic lice have six legs, but their two front legs are very large and look like
the pincher claws of a crab; this is how they got the nickname "crabs." Pubic lice are tan to grayish-white in
color. Females lay nits and are usually larger than males. To live, adult lice must feed on blood. If the louse falls
off a person, it dies within 1-2 days.
How is a pubic lice infestation diagnosed?
A lice infestation is diagnosed by looking closely through pubic hair for nits, nymphs, or adults. It may be
difficult to find nymph or adult; here are usually few of them and they can move quickly away from light. If
crawling lice are not seen, finding nits confirms that a person is infested and should be treated. If you are unsure
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about infestation or if treatment is not successful, see a health care provider for a diagnosis. About one third of
patients with pubic lice may have a second venereal disease and should be screened.
How is a pubic lice infestation treated?
A lice-killing shampoo (also called a pediculicide) made of 1% permethrin or pyrethrin is recommended to treat
pubic lice. These products are available without a prescription at your local drug store. Medication is generally
very effective; apply the medication exactly as directed on the bottle. A prescription medication, called Lindane
(1%) is available through your health care provider. Lindane is not recommended for pregnant or nursing
women, or for children less than 2 years old. Malathion* lotion 0.5% (Ovide*) is another prescription
medication that is effective against pubic lice.
8. AIDS (Acquired Immune Deficiency Syndrome)
What Causes AIDS?
Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome
(AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening
opportunistic infections.
How is HIV transmitted?
Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within
these body fluids HIV is present as both free virus particles and virus within infected immune cells. The three
major routes of transmission are unprotected sexual intercourse, contaminated needles and transmission from an
infected mother to her baby at birth or through breast milk.
Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any
of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or
insects), the pattern of reported AIDS cases would be much different from what has been observed. For
example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would
have been diagnosed with AIDS.
All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by
state and local health departments with the assistance, guidance, and laboratory support from CDC. No
additional routes of transmission have been recorded, despite a national sentinel system designed to detect just
such an occurrence.
Kissing
Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the
potential for contact with blood during "French" or open-mouth kissing, CDC recommends against engaging in
this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing
is believed to be very low. CDC has investigated only one case of HIV infection that may be attributed to
contact with blood during open-mouth kissing.
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Effectiveness of Condoms
Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA).
Condom manufacturers in the United States test each latex condom for defects, including holes, before it is
packaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging in
sexual intercourse--vaginal, anal, or oral--can greatly reduce a person’s risk of acquiring or transmitting
sexually transmitted diseases, including HIV infection.
There are many different types and brands of condoms available--however, only latex or polyurethane condoms
provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have been shown to
pass through natural membrane ("skin" or lambskin) condoms, which may contain natural pores and are
therefore not recommended for disease prevention (they are documented to be effective for contraception).
Women may wish to consider using the female condom when a male condom cannot be used.
For condoms to provide maximum protection, they must be used consistently (every time) and correctly.
Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this
country are less than 2 percent. Even when condoms do break, one study showed that more than half of such
breaks occurred prior to ejaculation.
When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time
among couples using them as their only method of contraception. Similarly, numerous studies among sexually
active people have demonstrated that a properly used latex condom provides a high degree of protection against
a variety of sexually transmitted diseases, including HIV infection.
9. Hepatitis B
What Is Hepatitis B?
Hepatitis B is a serious liver disease caused by a virus which is called hepatitis B virus (HBV).
How Common Is Hepatitis B?
One out of 20 people in the United States have been infected with HBV some time during their lives. In 2004,
an estimated 60,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die each
year from sickness caused by HBV.
How Do People Get Hepatitis B?
HBV is spread by having sex with an infected person. You are at risk of HBV infection by sexual contact if
you:




are a sex partner of someone who is infected with HBV
are sexually-active and are not in a long-term, mutually monogamous relationship (e.g., you have had
more than one sex partner in the previous 6 months)
have other STDs
are a man having sex with a man
HBV is spread by exposure to infected blood from skin puncture or contact with mucous membranes. You are
at risk of HBV infection from these exposures if you:
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



live in the same house with someone who is infected with HBV and share personal items such as
toothbrushes, razors, etc…
shoot drugs
have a job that involves contact with human blood or body fluids
have end stage kidney disease
HBV is spread from an infected mother to her infant during birth. HBV is not spread through food or water,
sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing, or casual contact.
What Are The Signs And Symptoms Of Hepatitis B?
Sometimes a person with HBV infection has no symptoms at all. Older people are more likely to have
symptoms. You might be infected with HBV (and be spreading the virus) and not know it.
If you have symptoms, they might include yellow skin or yellowing of the whites of your eyes (jaundice);
tiredness; loss of appetite; nausea; abdominal discomfort; dark urine; grey-colored bowel movements; or joint
pain.
What Are The Complications Of Hepatitis B?
Some people who become infected with HBV develop chronic (lifelong) infection.
Chronic infection increases the risk for cirrhosis (scarring of the liver), liver cancer, and liver failure. About
15%-25% of people with chronic HBV infection might die prematurely from liver cirrhosis or liver cancer.
How Does Hepatitis B Affect A Pregnant Woman And Her Baby?
HBV can be spread from an infected mother to her infant during birth. To prevent spread of HBV from infected
mothers to their infants, every woman should have her blood tested for hepatitis B surface antigen (HBsAg)
during each pregnancy.
Infants born to infected mothers need to get hepatitis B vaccine and another shot call HBIG (hepatitis B immune
globulin) soon after birth to prevent infection.
How Is Hepatitis B Diagnosed?
A blood test is the only way to diagnose hepatitis B.
What Is The Treatment For Hepatitis B?
There are no medications available for recently acquired (acute) HBV infection. There are antiviral drugs
available for the treatment of chronic HBV infection.
How Can Hepatitis B Be Prevented?
Hepatitis B vaccine is the best prevention against hepatitis B. Hepatitis B vaccine is recommended for all
infants, for children and adolescents who were not vaccinated as infants, and for all unvaccinated adults who are
at risk for HBV infection as well as any adult who wants to be protected against HBV infection.
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The surest way to avoid transmission of all sexually transmitted diseases is to abstain from sexual intercourse,
or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to
be uninfected.
Latex condoms, when used consistently and correctly, may reduce the risk of HBV transmission.
Never inject illegal drugs. If you are currently using, stop or get into a treatment program; if you can't stop,
never share needles, syringes, water, or "works.”

For further information about any sexually-transmitted disease, please visit the CDC
website at:
www.cdc.gov/
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